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1
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Sarre Lazcano C, Cardona K, Callegaro D. ASO Practice Guidelines Series: Multidisciplinary Management of Retroperitoneal Sarcomas. Ann Surg Oncol 2025:10.1245/s10434-025-17284-y. [PMID: 40346412 DOI: 10.1245/s10434-025-17284-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2025] [Accepted: 03/25/2025] [Indexed: 05/11/2025]
Abstract
Retroperitoneal sarcomas (RPS) represent a rare and biologically diverse group of malignancies, distinct from soft tissue sarcomas arising in other anatomic regions. Their deep-seated location, large size at presentation and proximity to critical structures contribute to diagnostic delays, treatment challenges, and variable oncologic outcomes, particularly when managed outside high-volume referral centers. Current international guidelines emphasize the importance of preoperative biopsy, review by a sarcoma pathologist, management in a referral center, multidisciplinary case discussion, consideration for clinical trials enrollment, and prospective database inclusion as standards of care. Given that the quality of the initial surgical resection-achieving complete macroscopic resection with margins tailored to the histologic type-remains the most important modifiable prognostic factor, adherence to international best practices in surgical and multimodal treatment is crucial to optimize patient outcomes. This article reviews contemporary management strategies for adult-type RPS, emphasizing the importance of multidisciplinary expertise.
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Affiliation(s)
- Catherine Sarre Lazcano
- Division of Surgical Oncology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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2
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Morinaga S, Aoki S, Tobiume M, Nishikawa G, Higuchi F, Ikenohata Y, Honda M, Kubo H, Sawada T, Yamada Y. Waldenström Macroglobulinemia Diagnosed by Ultrasonography-Guided Biopsy of the Right Perinephric Tumor. IJU Case Rep 2025; 8:271-275. [PMID: 40336752 PMCID: PMC12055227 DOI: 10.1002/iju5.70022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Revised: 12/24/2024] [Accepted: 03/25/2025] [Indexed: 05/09/2025] Open
Abstract
Introduction Waldenström macroglobulinemia is a low-grade B-cell lymphoma characterized by lymphoplasmacytic lymphoma infiltration of the bone marrow and immunoglobulin M (IgM) protein. Case Presentation An 80s-year-old male presented to our hospital with chief complaints of weight loss and general fatigue. Computed tomography (CT) showed homogeneous tumor around the kidney with elevated soluble Interleukin-2 receptor, serum IgM, and β2-microglobulin levels. Histopathological analysis by ultrasonography-guided biopsy revealed dense lymphocytic proliferation, plasmacytoid differentiation, and Dutcher bodies, positive for CD20, CD138, and IgM, but negative for CD3 and CD5, consistent with lymphoplasmacytic lymphoma. Bone marrow biopsy revealed infiltration of the lymphoplasmacytic lymphoma. The patient received four courses of bortezomib, cyclophosphamide, and dexamethasone along with dexamethasone, rituximab, and cyclophosphamide therapy. Twelve months after treatment, CT revealed only slightly enlarged abdominal para-aortic lymph nodes. Conclusion Malignant lymphoma in perinephric lesions is a relatively rare condition; however, a definitive diagnosis can be obtained by ultrasound-guided biopsy, allowing early initiation.
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Affiliation(s)
- Shingo Morinaga
- Department of UrologyJapan Community Health Care Organization Kani Tono HospitalKaniGifuJapan
| | - Shigeyuki Aoki
- Department of UrologyJapan Community Health Care Organization Kani Tono HospitalKaniGifuJapan
| | - Motoi Tobiume
- Department of UrologyJapan Organization of Occupational Health and Safety Asahi Rosai HospitalOwariasahiAichiJapan
| | - Genya Nishikawa
- Department of UrologyJapan Organization of Occupational Health and Safety Asahi Rosai HospitalOwariasahiAichiJapan
| | - Fusako Higuchi
- Department of Clinical LaboratoryJapan Community Health Care Organization Kani Tono HospitalKaniGifuJapan
| | - Yuusuke Ikenohata
- Division of NursingJapan Community Health Care Organization Kani Tono HospitalKaniGifuJapan
| | - Manabu Honda
- Division of RadiologyJapan Community Health Care Organization Kani Tono HospitalKaniGifuJapan
| | - Hiroe Kubo
- Division of Hospital and Clinic CoordinationJapan Community Health Care Organization Kani Tono HospitalKaniGifuJapan
| | - Tomoko Sawada
- Division of Hospital and Clinic CoordinationJapan Community Health Care Organization Kani Tono HospitalKaniGifuJapan
| | - Yoshiaki Yamada
- Department of UrologyJapan Community Health Care Organization Kani Tono HospitalKaniGifuJapan
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3
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Shadrack M, Salewi A, Poppe V, Amsi P, Sadiq A, Chilonga K. Idiopathic giant unilocular retroperitoneal cyst in a 38-years-old female: Diagnostic and management challenge in resource-limited health facility-A rare case report. Int J Surg Case Rep 2025; 129:111102. [PMID: 40048966 PMCID: PMC11928989 DOI: 10.1016/j.ijscr.2025.111102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Revised: 02/18/2025] [Accepted: 02/27/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Retroperitoneal cysts are rare, accounting for less than 1% of retroperitoneal tumors. Idiopathic giant unilocular retroperitoneal cysts are even more uncommon, with very few reported cases. Their diagnosis and management are particularly challenging in resource-limited settings due to restricted access to advanced imaging and surgical techniques. CASE PRESENTATION A 38-year-old female presented with progressive abdominal distension. Imaging revealed a giant retroperitoneal cyst. Due to limited resources, an open laparotomy was performed, and a 33 cm cyst containing 8 l of clear fluid was completely excised. Histopathology confirmed a giant idiopathic retroperitoneal cyst. DISCUSSION This case is unique due to the cyst's idiopathic nature, massive size, and successful surgical management despite resource constraints. Complete surgical excision remains the definitive management to prevent recurrence and complications. CONCLUSION This case highlights the importance of surgical intervention in managing giant retroperitoneal cysts in resource-constrained settings, ensuring favorable outcomes despite diagnostic limitations.
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Affiliation(s)
- Mathayo Shadrack
- Kilimanjaro Christian Medical Centre (KCMC), Box 3010, Moshi, Tanzania; Kilimanjaro Medical University College (KCMUCo), Box 2240, Moshi, Tanzania; Department of General Surgery, Kilimanjaro Christian Medical Center, Box 3010, Moshi, Kilimanjaro, Tanzania.
| | - Anande Salewi
- Kilimanjaro Christian Medical Centre (KCMC), Box 3010, Moshi, Tanzania; Kilimanjaro Medical University College (KCMUCo), Box 2240, Moshi, Tanzania; Department of General Surgery, Kilimanjaro Christian Medical Center, Box 3010, Moshi, Kilimanjaro, Tanzania
| | - Vanessa Poppe
- Kilimanjaro Christian Medical Centre (KCMC), Box 3010, Moshi, Tanzania; Kilimanjaro Medical University College (KCMUCo), Box 2240, Moshi, Tanzania; Department of General Surgery, Kilimanjaro Christian Medical Center, Box 3010, Moshi, Kilimanjaro, Tanzania
| | - Patrick Amsi
- Kilimanjaro Christian Medical Centre (KCMC), Box 3010, Moshi, Tanzania; Kilimanjaro Medical University College (KCMUCo), Box 2240, Moshi, Tanzania; Department of Histopathology, Kilimanjaro Christian Medical Center, Box 3010, Moshi, Kilimanjaro, Tanzania
| | - Adnan Sadiq
- Kilimanjaro Christian Medical Centre (KCMC), Box 3010, Moshi, Tanzania; Kilimanjaro Medical University College (KCMUCo), Box 2240, Moshi, Tanzania; Department of Radiology, Kilimanjaro Christian Medical Center, Box 3010, Moshi, Kilimanjaro, Tanzania
| | - Kondo Chilonga
- Kilimanjaro Christian Medical Centre (KCMC), Box 3010, Moshi, Tanzania; Kilimanjaro Medical University College (KCMUCo), Box 2240, Moshi, Tanzania; Department of General Surgery, Kilimanjaro Christian Medical Center, Box 3010, Moshi, Kilimanjaro, Tanzania
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4
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Imane B, Ramraoui ME, Boukis F, ElMouhafid F. Unmasking the uncommon: retroperitoneal Leiomyosarcoma case report. Oxf Med Case Reports 2025; 2025:omaf002. [PMID: 40162141 PMCID: PMC11952906 DOI: 10.1093/omcr/omaf002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Revised: 10/21/2024] [Accepted: 11/10/2024] [Indexed: 04/02/2025] Open
Abstract
Leiomyosarcoma is a rare subtype of soft tissue sarcoma originating from smooth muscle cells. The clinical presentation varies based on the tumor's location. We report the case of a 63-year-old woman with no significant medical history, who presented with persistent epigastric pain. A suspected lymphadenopathy was found on a CT scan. Following surgical excision, histopathology and immunohistochemistry confirmed the diagnosis of leiomyosarcoma, negative for CD117 and Dog1, but positive for H-Caldesmon. Retroperitoneal leiomyosarcoma is aggressive and rare, making diagnosis difficult prior to histopathology. Complete surgical resection with negative margins is the gold standard of treatment, though it can be challenging to achieve. A multidisciplinary approach is crucial to improve survival and quality of life. The patient is under regular follow-up and remains free of recurrence six months post-operatively.
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Affiliation(s)
- Boujguenna Imane
- Guelmim Faculty of Medicine and Pharmacy, Ibn Zohr Agadir University, Guelmim Morocco
| | | | - Fatima Boukis
- Al AMAL Pathological Anatomy Laboratory, Guelmim 81000, Morocco
| | - Faisal ElMouhafid
- Guelmim Military Hospital Moulay El Hassan General Surgery Department, Guelmim 81000, Morocco
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5
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Bahlouli N, Imrani K, Sara E, Chait F, Chaimae F, Nabil M, Nassar I, Samia S, Sabrine D, Zakia B, Amina BA, Youssef TO, Ismail L, Malki HOE, Lahcen I, Abdelkader B, Omar B. Mesenteric desmoid tumor in its cystic form: Case report of a very rare variant. Radiol Case Rep 2025; 20:980-988. [PMID: 39654563 PMCID: PMC11625238 DOI: 10.1016/j.radcr.2024.10.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 10/15/2024] [Accepted: 10/16/2024] [Indexed: 12/12/2024] Open
Abstract
Desmoid tumors, also known as deep fibromatosis or desmoid-type fibromatosis, represent a rare subset of deep fibromatoses. It is a locally aggressive tumor, with no specific symptoms, and no metastatic potential. We report a case of a 38-year-old male patient with an abdominal mass. Radiological findings showed 2 tumors, the first was a solid inguinal mass of the left lateral iliac pedicle, and the second was a giant cystic mass in the abdominal cavity. An elective explorative laparotomy was performed to remove the 2 masses. Histopathological examination confirmed the desmoid tumor diagnosis of both lesions.
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Affiliation(s)
- Nourrelhouda Bahlouli
- Department of Radiology, Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Kaouthar Imrani
- Department of Radiology, Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Esseti Sara
- Department of Radiology, Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Fatima Chait
- Department of Radiology, Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Faraj Chaimae
- Department of Radiology, Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Moatassimbillah Nabil
- Department of Radiology, Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Ittimad Nassar
- Department of Radiology, Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Sassi Samia
- Department of Pathology, Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Derqaoui Sabrine
- Department of Pathology, Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Bernoussi Zakia
- Department of Pathology, Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Babana Alaoui Amina
- Department of Surgery « A », Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Touhami Ouazzani Youssef
- Department of Surgery « A », Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Lahjomri Ismail
- Department of Surgery « A », Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Hadj Omar El Malki
- Department of Surgery « A », Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Ifrine Lahcen
- Department of Surgery « A », Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Belkouchi Abdelkader
- Department of Surgery « A », Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Belkouchi Omar
- Department of Surgery « A », Ibn Sina Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
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Turilli D, Anania M, Marras V, Pinna C, Piscopo L, Obinu M, Comune R, Porcu A, Scaglione M, Masala SA. Intraperitoneal pelvic leiomyoma with atypical location in an old man: The role for MRI in the differential diagnosis. Radiol Case Rep 2025; 20:937-942. [PMID: 39654571 PMCID: PMC11625112 DOI: 10.1016/j.radcr.2024.10.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 10/18/2024] [Accepted: 10/21/2024] [Indexed: 12/12/2024] Open
Abstract
Primary pelvic peritoneal masses, not arising from major organs, are uncommon in adults. Leiomyomas are a group of benign smooth muscle tumors, most commonly found in the uterus in premenopausal women (70-80%). Extra-uterine locations are very rare and more frequent in women. We highlighted the role of MRI due to its capability in soft tissue characterization, that may positively impact the therapeutical decision-making process. Herein, we present the case of a 66-year-old man with a peritoneal solid mass suspicious for a leiomyoma at Magnetic Resonance Imaging and confirmed at histologic specimen in order to discuss the crucial imaging findings that could raise suspicion of such a rare pathology in man.
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Affiliation(s)
- Davide Turilli
- Radiology Department of Surgery, Medicine and Pharmacy, University of Sassari, Viale S. Pietro, Sassari, Italy
| | - Marco Anania
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Vincenzo Marras
- Department of Biomedical Sciences, Institute of Pathology, University of Sassari, Sassari, Italy
| | - Claudia Pinna
- Radiology Department of Surgery, Medicine and Pharmacy, University of Sassari, Viale S. Pietro, Sassari, Italy
| | - Leandra Piscopo
- Radiology Department of Surgery, Medicine and Pharmacy, University of Sassari, Viale S. Pietro, Sassari, Italy
| | - Michele Obinu
- UO Diagnostica per Immagini Ospedale San Francesco Nuoro, Nuoro, Italy
| | - Rosita Comune
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Alberto Porcu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Mariano Scaglione
- Radiology Department of Surgery, Medicine and Pharmacy, University of Sassari, Viale S. Pietro, Sassari, Italy
| | - Salvatore Antonio Masala
- Radiology Department of Surgery, Medicine and Pharmacy, University of Sassari, Viale S. Pietro, Sassari, Italy
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7
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Polat YB, Gultekin MA, Akcay A, Karabulut UE, Atasoy B, Toprak H. Beyond the surface: A comprehensive radiological review of primary retroperitoneal neoplasms. Clin Imaging 2024; 116:110340. [PMID: 39509834 DOI: 10.1016/j.clinimag.2024.110340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 10/05/2024] [Accepted: 11/01/2024] [Indexed: 11/15/2024]
Abstract
Primary retroperitoneal neoplasms (PRNs) are a complex and diverse group of tumors arising in the retroperitoneal space, excluding those from retroperitoneal organs. These masses present significant diagnostic challenges due to their heterogeneous nature. PRNs primarily include sarcomas, neurogenic tumors, extragonadal germ cell tumors, and lymphomas, with the majority being malignant. This necessitates thorough evaluation by radiologists to assess resectability and the need for biopsy. Liposarcomas, the most common primary retroperitoneal sarcomas, and leiomyosarcomas, known for potential vessel involvement, exhibit distinct imaging patterns aiding differentiation. Neurogenic tumors, originating from nerve sheath, ganglionic, or paraganglionic cells, often appear in younger patients and have characteristic imaging features. Primary retroperitoneal extragonadal germ cell tumors are rare and are believed to originate from primordial germ cells that do not successfully migrate during embryonic development. Lymphomas are generally homogeneous on cross-sectional imaging; however, non-Hodgkin lymphomas can sometimes appear heterogeneous, complicating differentiation from other non-lipomatous retroperitoneal masses. Additionally, conditions like retroperitoneal fibrosis and Erdheim-Chester disease can mimic PRNs, complicating diagnosis and management. This review aims to provide radiologists with essential diagnostic points for identifying PRNs, emphasizing the importance of precise imaging interpretation. Understanding these distinctions is vital for guiding clinical management and optimizing patient outcomes.
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Affiliation(s)
- Yagmur Basak Polat
- Bezmialem Vakıf University Hospital, Department of Radiology, 34093 Istanbul, Turkey.
| | - Mehmet Ali Gultekin
- Bezmialem Vakıf University Hospital, Department of Radiology, 34093 Istanbul, Turkey
| | - Ahmet Akcay
- Bezmialem Vakıf University Hospital, Department of Radiology, 34093 Istanbul, Turkey
| | | | - Bahar Atasoy
- Bezmialem Vakıf University Hospital, Department of Radiology, 34093 Istanbul, Turkey
| | - Huseyin Toprak
- Bezmialem Vakıf University Hospital, Department of Radiology, 34093 Istanbul, Turkey
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8
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Zezoff D, Lowas S, Cleary M, Akalin A, Riaz F, Gauguet JM. Radiologic findings of an adolescent epithelioid inflammatory myofibroblastic sarcoma. Radiol Case Rep 2024; 19:6199-6204. [PMID: 39376959 PMCID: PMC11456812 DOI: 10.1016/j.radcr.2024.08.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 10/09/2024] Open
Abstract
Epithelioid inflammatory myofibroblastic sarcoma, a variant of the inflammatory myofibroblastic tumor, is a rare tumor that is not well described in the radiologic literature. We present a case of a 14-year-old male adolescent who presented with fever, fatigue, and weight loss symptoms and was found to have an abdominal mass on contrast enhanced CT. Initial differentials included lymphoma, pheochromocytoma, desmoid, and sarcoma, and pathological evaluation revealed an epithelioid inflammatory myofibroblastic sarcoma. The mass was separate from the surrounding structures of the left upper abdomen with unique radiologic features not previously described in the literature. Prior literature examples of epithelioid inflammatory myofibroblastic sarcoma described a heterogenous, enhancing lobulated mass, and our case was a lobulated, avidly enhancing homogenous mass on CT with surrounding inflammation and avid uptake on PET/CT. In addition to the imaging features, we describe the surgical findings, the pathologic features of the tumor, and the oncologic treatment of this patient. This case highlights the importance of including rare tumors such as epithelioid inflammatory myofibroblastic sarcoma as a potential differential consideration of an avidly enhancing homogenous abdominal mass in an adolescent.
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Affiliation(s)
- David Zezoff
- Department of Radiology, Saint Vincent Hospital, Worcester, MA 01608, USA
| | - Stefanie Lowas
- Department of Pediatrics, Division of Oncology, UMass Memorial Health, Worcester, MA 01655, USA
| | - Muriel Cleary
- Department of Surgery, Division of Pediatric Surgery, UMass Memorial Health, Worcester, MA 01655, USA
| | - Ali Akalin
- Department of Pathology, UMass Memorial Health, Worcester, MA 01655, USA
| | - Farhana Riaz
- Department of Radiology, Division of Pediatric Radiology, UMass Memorial Health, Worcester, MA 01655, USA
| | - Jean-Marc Gauguet
- Department of Radiology, Division of Pediatric Radiology, UMass Memorial Health, Worcester, MA 01655, USA
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9
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Santiana L, Khairuddin R, Hernowo BS. Intraabdominal mature cystic teratoma in a 20-year-old male: A rare case. Radiol Case Rep 2024; 19:5119-5123. [PMID: 39263503 PMCID: PMC11387537 DOI: 10.1016/j.radcr.2024.07.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 09/13/2024] Open
Abstract
Teratomas are the most prevalent type of germ cell tumors and usually display benign characteristics. Mature cystic teratomas consist of a varied mixture of mature tissue types that originate from squamous epithelium and skin adnexal structures. It is most commonly found in female gonads. A mature teratoma located in the abdomen of an adult male patient is exceptionally uncommon. In this case, we report a rare case of intra-abdominal mature cystic teratoma in an adult male.
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Affiliation(s)
- Leni Santiana
- Department of Radiology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Rais Khairuddin
- Department of Radiology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Bethy S Hernowo
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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10
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Zhang J, Niu X, Li J, Da M. A rare case of complete resection of giant retroperitoneal neurofibroma. Asian J Surg 2024:S1015-9584(24)02141-9. [PMID: 39353777 DOI: 10.1016/j.asjsur.2024.09.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 09/02/2024] [Accepted: 09/12/2024] [Indexed: 10/04/2024] Open
Affiliation(s)
- Junrui Zhang
- The First School of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Xingdong Niu
- The First School of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Jian Li
- The First School of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - MingXu Da
- Department of Surgical Oncology, Gansu Provincial Hospital, Lanzhou, 730000, China.
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11
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Mitsuo K, Kaneko H, Tsukamoto M, Asami Y, Miyazawa A, Miyashita K, Onoda G, Yamashita H, Hatano M, Kamiyama M, Okuda S. Retroperitoneal leiomyosarcoma mimicking an ovarian tumor diagnosed using a negative ovarian pedicle sign. Radiol Case Rep 2024; 19:3429-3433. [PMID: 38872746 PMCID: PMC11169071 DOI: 10.1016/j.radcr.2024.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 06/15/2024] Open
Abstract
Retroperitoneal leiomyosarcoma (RPLMS) is rare and usually presents as a large abdominal mass with poor clinical symptoms. Radiological findings of an RPLMS arising in the pelvis of a woman resemble those of adnexal tumors. Herein, we present a case of RPLMS mimicking an adnexal tumor which was differentiated from having an ovarian origin as the right ovarian vein was passing through the tumor but there was no direct vascular connection with the tumor. Therefore, it is important to identify the ovarian vein to distinguish between these tumors.
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Affiliation(s)
- Koji Mitsuo
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Hideki Kaneko
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Makoto Tsukamoto
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Yuta Asami
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Azumi Miyazawa
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Keiichi Miyashita
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Go Onoda
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | | | - Mami Hatano
- Department of Pathology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Megumi Kamiyama
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Shigeo Okuda
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
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12
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Cui Y, Zhao Y, Chen X, Jiang Y, Mao H, Ju S, Peng XG. Value of Non-Contrast-Enhanced Vessel Wall MR Imaging in Assessing Vascular Invasion of Retroperitoneal Tumors. J Magn Reson Imaging 2024; 60:752-764. [PMID: 37929323 DOI: 10.1002/jmri.29120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Due to their location and growth patterns, retroperitoneal tumors often involve the surrounding blood vessels. Clinical decisions on a proper treatment depend on the information on this condition. Evaluation of blood vessels using non-contrast-enhanced vessel wall MRI may provide noninvasive assessment of the extent of tumor invasion to assist clinical decision-making. PURPOSE To investigate the performance and potential of non-contrast-enhanced vessel wall MRI in evaluating the degree of vessel wall invasion of retroperitoneal tumors. STUDY TYPE Prospective. POPULATION Thirty-seven participants (mean age: 60.59 ± 11.77 years, 59% male) with retroperitoneal tumors close to vessels based on their diagnostic computer tomography. FIELD STRENGTH/SEQUENCES 3 T; vessel wall MRI sequences: two-dimensional T2-weighted MultiVane XD turbo spin-echo (2D-T2-MVXD-TSE) and three-dimensional T1-weighted motion sensitized driven equilibrium fat suppression turbo spin-echo (3D-T1-MSDE-TSE) sequences; conventional MRI sequences: T2-weighted fat suppression turbo spin-echo (T2-FS-TSE), T2-weighted turbo spin-echo (T2-TSE), modified Dixon T1-weighted fast field echo (T1-mDixon-FFE), and diffusion-weighted echo planar imaging (DWI-EPI) sequences. ASSESSMENT All patients underwent preoperative imaging using both non-contrast conventional and vessel wall MRI sequences. Images obtained from conventional and vessel wall MRI sequences were evaluated independently by three junior radiologists (3 and 2 years of experience in reading MRI) and reviewed by one senior radiologist (25 years of experience in reading MRI) to assess the degree of vessel wall invasion. MRI were validated results from the clinical standard diagnosis based on surgical confirmation or histopathological reports. Interobserver agreement was determined based on the reports from three readers with similar years of experiences. Intraobserver variability was assessed based on categorizing and recategorizing the vessels of 37 patients 1 month apart. STATISTICAL TESTS Intra-class correlation efficient (ICC), Chi-square test, McNemar test, area under the receiver-operating characteristic curve (AUC), Delong test, P < 0.05 was considered significant. RESULTS The accuracy of vessel wall MRI (91.96%, 95% CI: 85.43-95.71; 103 of 112) in detecting the degree of vessel wall invasion was significantly higher than that of conventional MRI (75%, 95% CI: 66.24-82.10; 84 of 112). The interobserver variability or reproducibility in categorization of the degree of vascular wall invasion was good in evaluating images from conventional and vessel wall MRI sequences (ICC = 0.821, 95% CI: 0.765-0.867 and ICC = 0.881, 95% CI: 0.842-0.913, respectively). DATA CONCLUSION Diagnosis of vessel wall invasion of retroperitoneal tumors and assessment of its severity can be improved by using non-contrast-enhanced vessel wall MRI. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Ying Cui
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Yufei Zhao
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Xiaohui Chen
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Yang Jiang
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Hui Mao
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Shenghong Ju
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Xin-Gui Peng
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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13
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Tuan HX, Tuan TA, Tam NT, Cong HD, Duy NQ, Hung ND, Ceugnart L, Duc NM. An infrequent case of retroperitoneal synovial sarcoma. Radiol Case Rep 2024; 19:3456-3460. [PMID: 38872739 PMCID: PMC11169068 DOI: 10.1016/j.radcr.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 06/15/2024] Open
Abstract
Synovial sarcoma (SS) is an uncommon malignant tumor, ranking third in prevalence within the soft tissue sarcomas group. The vast majority of synovial sarcomas are present in the extremities, with only 15% developing in the retroperitoneal space. Retroperitoneal synovial sarcoma (RSS) is an infrequent case of SS, with only about 20 cases reported in the literature. Diagnosing RSS before treatment remains challenging because of its nonspecific clinical symptoms. The disease is often detected at a later stage, leading to additional damage to other organs as well as complicated and ineffective treatment. Consequently, the 5-year survival rate is only 20%-29%. This report introduces a case of RSS in a 19-year-old male patient with imaging characteristics on computed tomography (CT) and magnetic resonance (MR).
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Affiliation(s)
- Ho Xuan Tuan
- Department of Medical Imaging, Da Nang University of Medical Technology and Pharmacy, Danang, Vietnam
| | - Trinh Anh Tuan
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen-Thi Tam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Ho Duc Cong
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Ngo Quang Duy
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
- Department of Radiology, Ha Giang General Hospital, Ha Giang, Vietnam
| | - Nguyen Duy Hung
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Luc Ceugnart
- Departement of Radiology, Centre Oscar Lambret, Lille, France
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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14
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Boekestijn B, Wasser MNJM, Mieog JSD, DeRuiter MC. Retroperitoneum revisited: a review of radiological literature and updated concept of retroperitoneal fascial anatomy with imaging features and correlating anatomy. Surg Radiol Anat 2024; 46:1165-1175. [PMID: 38963431 PMCID: PMC11246311 DOI: 10.1007/s00276-024-03432-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE Spread of disease in the retroperitoneum is dictated by the complex anatomy of retroperitoneal fasciae and is still incompletely understood. Conflicting reports have led to insufficient and incorrect anatomical concepts in radiological literature. METHODS This review will discuss previous concepts prevalent in radiological literature and their shortcomings will be highlighted. New insights from recent anatomical and embryological research, together with imaging examples, will be used to clarify patterns of disease spread in the retroperitoneum that remain unexplained by these concepts. RESULTS The fusion fascia and the renal fascia in particular give rise to planes and spaces that act as vectors for spread of disease in the retroperitoneum. Some of these planes and structures, such as the caudal extension of the renal fascia, have previously not been described in radiological literature. CONCLUSION New insights, including the various fasciae, potential spaces and planes, are incorporated into an updated combined retroperitoneal fascial concept.
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Affiliation(s)
- B Boekestijn
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
| | - M N J M Wasser
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - J S D Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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15
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Nikas S, Zonitsa S, Anastasiadis P, Veniadou K, Roumelioti S, Mitsas AC, Gerasopoulos G, Gkouvis P. A Rare Case of Retroperitoneal Tumefactive Fibroinflammatory Lesion Related to IgG4-Sclerosing Disease. Cureus 2024; 16:e61968. [PMID: 38978945 PMCID: PMC11230138 DOI: 10.7759/cureus.61968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2024] [Indexed: 07/10/2024] Open
Abstract
We present a unique case of a retroperitoneal tumefactive fibroinflammatory lesion related to IgG4-sclerosing disease; it is a rare manifestation of the IgG4-related disease, which usually causes diffuse fibrosis when located in the retroperitoneum, rather than mass-like lesions. A 49-year-old man presented to the emergency department complaining of abdominal pain and vomiting. Subsequent testing with abdominal ultrasound, CT, and MRI revealed a large retroperitoneal mass of unknown origin, heterogenous, with a concentric circles pattern best visualized in MRI. The lesion was resected, and the histological and immunohistochemical studies revealed an IgG4-related tumefactive fibroinflammatory lesion of the retroperitoneum.
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Affiliation(s)
- Spyridon Nikas
- Radiology Department, General Hospital of Imathia, Veria Unit, Veria, GRC
| | - Sotiria Zonitsa
- Radiology Department, General Hospital of Imathia, Veria Unit, Veria, GRC
| | | | - Kalliopi Veniadou
- Radiology Department, General Hospital of Imathia, Veria Unit, Veria, GRC
| | - Sofia Roumelioti
- Radiology Department, General Hospital of Imathia, Veria Unit, Veria, GRC
| | - Angelos C Mitsas
- Surgical Department, General Hospital of Imathia, Veria Unit, Veria, GRC
| | | | - Panagiotis Gkouvis
- Radiology Department, General Hospital of Imathia, Veria Unit, Veria, GRC
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16
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Pathak P, Abandeh L, Aboughalia H, Pooyan A, Mansoori B. Overview of F18-FDG uptake patterns in retroperitoneal pathologies: imaging findings, pitfalls, and artifacts. Abdom Radiol (NY) 2024; 49:1677-1698. [PMID: 38652126 DOI: 10.1007/s00261-023-04139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Retroperitoneum can be the origin of a wide variety of pathologic conditions and potential space for disease spread to other compartments of the abdomen and pelvis. Computed tomography (CT) and magnetic resonance imaging (MRI) are often the initial imaging modalities to evaluate the retroperitoneal pathologies, however given the intrinsic limitations, F18-FDG PET/CT provides additional valuable metabolic information which can change the patient management and clinical outcomes. We highlight the features of retroperitoneal pathologies on F18-FDG PET/CT and the commonly encountered imaging artifacts and pitfalls. The aim of this review is to characterize primary and secondary retroperitoneal pathologies based on their metabolic features, and correlate PET findings with anatomic imaging. CONCLUSION Retroperitoneal pathologies can be complex, ranging from oncologic to a spectrum of non-oncologic disorders. While crosse-sectional imaging (CT and MRI) are often the initial imaging modalities to localize and characterize pathologies, metabolic information provided by F18-FDG PET/CT can change the management and clinical outcome in many cases.
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Affiliation(s)
- Priya Pathak
- Abdominal Imaging and Nuclear Medicine Divisions, Department of Radiology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
| | - Laith Abandeh
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Hassan Aboughalia
- Department of Radiology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Atefe Pooyan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Bahar Mansoori
- Abdominal Imaging Division, Department of Radiology, University of Washington, Seattle, WA, USA
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17
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Sebai A, Elaifia R, Atri S, Mahmoud AB, Haddad A, Kacem JM. Primary giant hydatid cyst of the retroperitoneum: Diagnosis and therapeutic approaches. Int J Surg Case Rep 2024; 117:109484. [PMID: 38471222 PMCID: PMC10945243 DOI: 10.1016/j.ijscr.2024.109484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary hydatid cyst of the retroperitoneum is an exceedingly rare manifestation of hydatid disease. Diagnosis proves challenging due to nonspecific symptoms, and the condition is typically not suspected when facing a retroperitoneal cystic mass, necessitating awareness among clinicians and surgeons, particularly in endemic regions. CASE PRESENTATION A 45-year-old male with a three-month history of progressive abdominal enlargement and pain. Living in a rural area, he exhibited a 30 cm, well-defined retroperitoneal cyst, with no guarding confirmed by CT-scan, with characteristic daughter cysts. The diagnosis of primary retroperitoneal hydatid cyst was supported by positive hydatid serology and eosinophilia. Surgical intervention was crucial, and a complete pericystectomy, with 4 cm of pericyst on the aorta due to safety concerns, was performed after three months of preoperative albendazole-based treatment. The postoperative course was uneventful, and a two-year follow-up revealed no recurrence. CLINICAL DISCUSSION The prevalence of hydatid disease in North Africa is high, yet retroperitoneal cases are rare. The difficulty to diagnosis retroperitoneal masses, underscores the importance of precise patient evaluation and detailed imaging analysis. Percutaneous puncture is contraindicated due to the risk of dissemination, highlighting even more the significance of accurate preoperative diagnosis. Surgery, coupled with Albendazole treatment, remains the gold-standard, associated with meticulous intraoperative precautions to prevent disease dissemination. CONCLUSION Primary retroperitoneal hydatid cyst is rare. Diagnosis is difficult. Precise determination of patient's background and detailed analysis of imaging findings are mandatory. Percutaneous puncture is forbidden as it leads to disease spreading or even anaphylactic shock. Surgical excision is the gold-standard.
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Affiliation(s)
- A Sebai
- The Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia; Surgery Department A, Rabta Hospital, Tunis, Tunisia
| | - R Elaifia
- The Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia; Surgery Department A, Rabta Hospital, Tunis, Tunisia.
| | - S Atri
- The Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia; Surgery Department A, Rabta Hospital, Tunis, Tunisia
| | - A Ben Mahmoud
- The Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia; Surgery Department A, Rabta Hospital, Tunis, Tunisia
| | - A Haddad
- The Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia; Surgery Department A, Rabta Hospital, Tunis, Tunisia
| | - J M Kacem
- The Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia; Surgery Department A, Rabta Hospital, Tunis, Tunisia
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18
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Yamagata Y, Komiyama M, Iwata S. Clinical characteristics and management of primary retroperitoneal sarcoma: A literature review. Ann Gastroenterol Surg 2024; 8:21-29. [PMID: 38250690 PMCID: PMC10797828 DOI: 10.1002/ags3.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/21/2023] [Accepted: 10/29/2023] [Indexed: 01/23/2024] Open
Abstract
Retroperitoneal sarcoma (RPS) is a rare tumor classified into many histological types. It is also often detected only after it has grown to a considerable size and requires extensive resection of the surrounding organs, making it difficult to offer optimal patient-tailored management. Evidence supporting specific treatment modalities for RPS is insufficient, owing to its rarity. The Japanese clinical practice guidelines for RPS were published in December 2021, with the aim of accumulating existing evidence and indicating the optimal practice for RPS. These guidelines provide important clinical questions (CQs) concerning the diagnosis and treatment of RPS. This review, with a particular focus on primary RPS, attempts to introduce clinical problems in the diagnosis and treatment of RPS and to assess those problems along with the CQs in the guidelines. According to these guidelines, although chemotherapy and radiotherapy are expected to have therapeutic effects, the level of evidence to support these treatments is not very high at present. Accordingly, complete resection of the tumor is the first and only option for managing primary RPS. However, as with other tumors, the demand for multidisciplinary treatment for RPS is increasing. These guidelines will undoubtedly represent a milestone in clinical practice in relation to RPS in the future, and further evidence is expected to be accumulated based on the CQs that have been proposed.
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Affiliation(s)
- Yukinori Yamagata
- Department of Gastric SurgeryNational Cancer Center HospitalCyuo‐kuJapan
| | | | - Shintaro Iwata
- Department of Musculoskeletal Oncology and RehabilitationNational Cancer Center HospitalCyuo‐kuJapan
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19
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Pandey A, Kumar D, Gupta P, Khosla D, Periasamy K, Kapoor R. Primary retroperitoneal squamous cell carcinoma: a literature review. J Cancer Res Clin Oncol 2023; 149:12507-12512. [PMID: 37353604 DOI: 10.1007/s00432-023-04969-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/03/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE Retroperitoneal squamous cell carcinoma is an extremely rare histological variant of retroperitoneal tumors. The exact etiology and origin of the same is still unknown. To date, only a few case reports have been published in the literature. Due to rarity, standard treatment protocol is not available. The article aims to review the literature and treatment options available for this uncommon entity, based on available data. METHODS We searched the databases like PubMed, PubMed Central, Scopus, and Google Scholar with the keywords "Squamous cell carcinoma" and "retroperitoneal tumors". Peer-reviewed and recent articles were screened. RESULTS Seven relevant articles comprising 14 cases were found. Due to the small number of reports, tabulation of treatment details and outcome was done. Like the sarcoma variant, these tumors also present with a large mass in the abdomen and abdominal discomfort. Association with human papillomavirus appears to be the most common factor that gives rise to squamous histology. CONCLUSION Retroperitoneal SCC is an uncommonly diagnosed entity. Although no specific treatment guidelines exist for this uncommon malignancy; surgery followed by adjuvant or definitive radiotherapy with concurrent chemotherapy (in inoperable cases) seems a feasible option. Multicentre trials should be conducted for establishing definitive treatment strategies for this ailment.
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Affiliation(s)
- Ankita Pandey
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divyesh Kumar
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Parikshaa Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kannan Periasamy
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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20
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Li X, Zhang W. Clinical application of real-time PET/CT guided targeted retroperitoneal masses biopsy in diagnosing malignant tumors. BMC Cancer 2023; 23:829. [PMID: 37670264 PMCID: PMC10481464 DOI: 10.1186/s12885-023-11334-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE To explore the feasibility, safety, and clinical application value based on the fusion image of 18 F-FDG PET/CT, for guiding retroperitoneal puncture biopsy technology and to determine the diagnosis of retroperitoneal masses in diagnosing malignant tumors. METHODS From March 2019 to January 2023, 42 patients underwent 18 F-FDG PET/CT imaging and were found to have retroperitoneal lesions that required definite diagnosis; 22 were male, 20 were female, and the average age was(59.17 ± 13.23) years. According to the fused 18 F-FDG PET/CT tomographic image, the target point with the highest metabolic activity, the safest, and expected maximum sample size was selected. CT scans were acquired with the same machine and fused with 18 F-FDG PET, guiding the puncture biopsy needle to approach the expected target zone, enabling timely delivery of pathological and immunohistochemical examination of the biopsy. Success rate, total examination time, biopsy operation time, complications, CT radiation dose, pathological, and immunohistochemical results were recorded. RESULTS All 42 patients were sampled successfully with the successful rate being 100%. The site of sampling of 42 patients accurately targeted the highest metabolic activity, the safest, and the expected maximum sample size. All 42 patients received clear diagnosis (25 cases of malignant tumors and cases of 17 benign tissues). 15 cases of patients had a change in clinical diagnosis, accounting for 35.7% of all patients, and affecting subsequent treatment plans. The average total examination time for patients was (41.3 ± 7.3) minutes, and the biopsy operation time was (29.1 ± 8.7) minutes. The effective radiation dose generated by the entire examination generated by CT guidance was (2.0 ± 0.5) mSv; no severe complications occurred in the patients. CONCLUSION Real-time-guided retroperitoneal puncture biopsy based on 18 F-FDG PET/CT fusion image is safe, accurate, and feasible, and can provide patients of retroperitoneal mass with clear pathological diagnosis and immunohistochemical evaluation.
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Affiliation(s)
- Xiaomin Li
- Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Longcheng Street NO.99, 030032 Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Wanchun Zhang
- Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Longcheng Street NO.99, 030032 Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
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21
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Sorour S, Bao B, Wilson MP, Low G. Cystic retroperitoneal dedifferentiated liposarcoma: A case report. J Clin Imaging Sci 2023; 13:22. [PMID: 37680250 PMCID: PMC10481824 DOI: 10.25259/jcis_48_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/18/2023] [Indexed: 09/09/2023] Open
Abstract
Liposarcoma is the most common primary retroperitoneal sarcoma in adults. We report the case of an 86-year-old male who presented to the emergency department with frequent falls and unexplained weight loss that was found to have a cystic retroperitoneal dedifferentiated liposarcoma. Initial computed tomography revealed a large heterogeneous complex cystic hypoenhancing lesion in the left retroperitoneum. Subsequent magnetic resonance imaging demonstrates a multilocular cystic mass with microscopic lipid content, diffusion restriction, and enhancing nodular soft-tissue components. Histologic examination of the tissue sample following biopsy is consistent with cystic retroperitoneal dedifferentiated liposarcoma. Further management was not pursued due to the patient's advanced age and frailty.
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Affiliation(s)
- Sara Sorour
- Department of Radiology and Diagnostic Imaging, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Canada
| | - Bo Bao
- Department of Radiology and Diagnostic Imaging, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Canada
| | | | - Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
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22
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Nahle AA, Hamdar H, Jawad A, Obaied Alahmar F. Primary neuroendocrine tumor in the retroperitoneal cavity: A rare case report. Int J Surg Case Rep 2023; 109:108506. [PMID: 37459696 PMCID: PMC10384550 DOI: 10.1016/j.ijscr.2023.108506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Neuroendocrine tumors (NETs) are rare malignancies, accounting for a small percentage of gastrointestinal and bronchopulmonary cancers. Retroperitoneal NETs are infrequent and can be primary or metastatic. They are commonly metastatic rather than primary tumors, with primary retroperitoneal NETs being exceptionally rare. CASE PRESENTATION A 38-year-old woman presented with left flank pain persisting for one year, which had progressively worsened. Imaging revealed a large retroperitoneal mass exerting pressure on the stomach, spleen, liver, and upper pole of the left kidney. A biopsy of the tumor was done and the results were consistent with NET. The tumor, which measured approximately 19 × 12.5 × 11 cm, was surgically removed, and the pathological findings were consistent with the results of the biopsy prior to the surgery. CLINICAL DISCUSSION Neuroendocrine tumors are rare and exhibit diverse characteristics based on location, size, hormone secretion, and metastasis. Retroperitoneal neuroendocrine tumors are typically metastatic and rarely primary. The extremely large size of the tumor in this case highlights the surgical challenges associated with retroperitoneal NETs. Imaging, such as CT and MRI, plays a crucial role in diagnosis. CONCLUSION The study emphasizes the need to consider primary NETs as a possible cause of large retroperitoneal masses, especially if the tumor size is significant. Surgical resection is the primary treatment option with generally favorable outcomes. However, the size of the tumor can complicate treatment, and further research is needed to evaluate the effectiveness of postoperative adjuvant therapy and develop therapeutic approaches for recurrent NETs.
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Affiliation(s)
| | - Hussein Hamdar
- Damascus University, Faculty of Medicine, Damascus, Syria.
| | - Ali Jawad
- Damascus University, Faculty of Medicine, Damascus, Syria
| | - Fadi Obaied Alahmar
- Department of General Surgery, Al Assad University Hospital, Damascus University, Damascus, Syria
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23
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Pacella G, Brunese MC, Donnarumma F, Barrassi M, Bellifemine F, Sciaudone G, Vallone G, Guerra G, Sallustio G. Imaging of Ganglioneuroma: A Literature Review and a Rare Case of Cystic Presentation in an Adolescent Girl. Diagnostics (Basel) 2023; 13:2190. [PMID: 37443583 DOI: 10.3390/diagnostics13132190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Retroperitoneal ganglioneuroma is a rare neuroectodermal tumor with a benign nature. We performed a literature review among 338 studies. We included 9 studies, whose patients underwent CT and/or MRI to characterize a retroperitoneal mass, which was confirmed to be a ganglioneuroma by histologic exam. The most common features of ganglioneuroma are considered to be a solid nature, oval/lobulated shape, and regular margins. The ganglioneuroma shows a progressive late enhancement on CT. On MRI it appears as a hypointense mass in T1W images and with a heterogeneous high-intensity in T2W. The MRI-"whorled sign" is described in the reviewed studies in about 80% of patients. The MRI characterization of a primitive retroperitoneal cystic mass should not exclude a cystic evolution from solid masses, and in the case of paravertebral location, the differential diagnosis algorithm should include the hypothesis of ganglioneuroma. In our case, the MRI features could have oriented towards a neurogenic nature, however, the predominantly cystic-fluid aspect and the considerable longitudinal non-invasive extension between retroperitoneal structures, misled us to a lymphatic malformation. In the literature, it is reported that the cystic presentation can be due to a degeneration of a well-known solid form while maintaining a benign character: the distinguishing malignity character is the revelation of immature cells on histological examination.
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Affiliation(s)
- Giulia Pacella
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
| | | | - Michele Barrassi
- Department of Radiology, Cardarelli Hospital, 86100 Campobasso, Italy
| | - Fabio Bellifemine
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Guido Sciaudone
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Gianfranco Vallone
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Germano Guerra
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
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Cao Y, Wang Z, Ren J, Liu W, Da H, Yang X, Bao H. Differentiation of retroperitoneal paragangliomas and schwannomas based on computed tomography radiomics. Sci Rep 2023; 13:9253. [PMID: 37286581 PMCID: PMC10247726 DOI: 10.1038/s41598-023-28297-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/16/2023] [Indexed: 06/09/2023] Open
Abstract
The purpose of this study was to differentiate the retroperitoneal paragangliomas and schwannomas using computed tomography (CT) radiomics. This study included 112 patients from two centers who pathologically confirmed retroperitoneal pheochromocytomas and schwannomas and underwent preoperative CT examinations. Radiomics features of the entire primary tumor were extracted from non-contrast enhancement (NC), arterial phase (AP) and venous phase (VP) CT images. The least absolute shrinkage and selection operator method was used to screen out key radiomics signatures. Radiomics, clinical and clinical-radiomics combined models were built to differentiate the retroperitoneal paragangliomas and schwannomas. Model performance and clinical usefulness were evaluated by receiver operating characteristic curve, calibration curve and decision curve. In addition, we compared the diagnostic accuracy of radiomics, clinical and clinical-radiomics combined models with radiologists for pheochromocytomas and schwannomas in the same set of data. Three NC, 4 AP, and 3 VP radiomics features were retained as the final radiomics signatures for differentiating the paragangliomas and schwannomas. The CT characteristics CT attenuation value of NC and the enhancement magnitude at AP and VP were found to be significantly different statistically (P < 0.05). The NC, AP, VP, Radiomics and clinical models had encouraging discriminative performance. The clinical-radiomics combined model that combined radiomics signatures and clinical characteristics showed excellent performance, with an area under curve (AUC) values were 0.984 (95% CI 0.952-1.000) in the training cohort, 0.955 (95% CI 0.864-1.000) in the internal validation cohort and 0.871 (95% CI 0.710-1.000) in the external validation cohort. The accuracy, sensitivity and specificity were 0.984, 0.970 and 1.000 in the training cohort, 0.960, 1.000 and 0.917 in the internal validation cohort and 0.917, 0.923 and 0.818 in the external validation cohort, respectively. Additionally, AP, VP, Radiomics, clinical and clinical-radiomics combined models had a higher diagnostic accuracy for pheochromocytomas and schwannomas than the two radiologists. Our study demonstrated the CT-based radiomics models has promising performance in differentiating the paragangliomas and schwannomas.
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Affiliation(s)
- Yuntai Cao
- Department of Radiology, Affiliated Hospital of Qinghai University, Tongren Road No.29, Xining, 810001, People's Republic of China.
| | - Zhan Wang
- Department of Biomedical Engineering, Tsinghua University, Beijing, People's Republic of China
| | - Jialiang Ren
- Department of Pharmaceuticals Diagnosis, GE Healthcare, Beijing, People's Republic of China
| | - Wencun Liu
- Department of Radiology, Chongqing Jiulongpo People's Hospital, Chongqing, People's Republic of China
| | - Huiwen Da
- Department of Radiology, Affiliated Hospital of Qinghai University, Tongren Road No.29, Xining, 810001, People's Republic of China
| | - Xiaotong Yang
- Department of Radiology, Affiliated Hospital of Qinghai University, Tongren Road No.29, Xining, 810001, People's Republic of China
| | - Haihua Bao
- Department of Radiology, Affiliated Hospital of Qinghai University, Tongren Road No.29, Xining, 810001, People's Republic of China.
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25
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Sarre-Lazcano C, Dumitra S, Fiore M. Pelvic soft tissue sarcomas. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1102-1110. [PMID: 35725682 DOI: 10.1016/j.ejso.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 12/20/2022]
Abstract
Pelvic soft tissue sarcomas (PSTS) are a rare, heterogeneous group of tumors. They have been usually analyzed with retroperitoneal sarcomas (RPS), but actually have key differences. Due to their unique anatomic location, symptomatic presentation of PSTS may be more common than RPS. Adequate imaging approach is paramount for guiding differential diagnosis, while preoperative biopsy is mandatory, especially when preoperative treatment may be considered as initial approach. The most frequent histologic subtype is leiomyosarcoma, which is different as expected in the retroperitoneum where liposarcoma is the commonest histology. Also solitary fibrous tumor is commonly diagnosed in the pelvis. Surgical approach for PSTS differs from that for RPS mainly due to anatomic relations. Similarly, in the lack of definite evidence from specific trials about neoadjuvant and adjuvant treatments, the anatomic constraints to obtain wide margins in the pelvis as well as the expected functional outcome in case of organ resections should be factored into decision for individualized treatment offer. Vascular and genitourinary involvement are frequent, as well as herniation through pelvic foramina. For these reasons a multidisciplinary surgical team should always be considered. Early referral of these patients to high-volume centers is critical and may impact on survival, given that optimal initial resection is a major predictor of curative treatment. International consensus on PSTS treatment is advocated, similarly to the recent efforts realized for RPS.
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Affiliation(s)
- Catherine Sarre-Lazcano
- Department of Surgery, Salvador Zubiran National Institute of Medical Sciences and Nutrition: Salvador Zubiran, Mexico City, Mexico
| | - Sinziana Dumitra
- Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Porrello G, Cannella R, Randazzo A, Badalamenti G, Brancatelli G, Vernuccio F. CT and MR Imaging of Retroperitoneal Sarcomas: A Practical Guide for the Radiologist. Cancers (Basel) 2023; 15:cancers15112985. [PMID: 37296946 DOI: 10.3390/cancers15112985] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
Primary retroperitoneal sarcomas (RPS) represent around 10-16% of all sarcomas, with liposarcomas and leiomyosarcomas being the most common subtypes. RPS have some peculiar characteristics, imaging appearances, worse prognosis, and complications compared to other locations of sarcoma. Commonly, RPS primarily present as large masses, progressively encasing adjacent structures, causing mass effect, and complications. RPS diagnosis is often challenging, and these tumors may be overlooked; however, failure to recognize RPS characteristics leads to a worse prognosis for the patients. Surgery is the only recognized curative treatment, but the anatomical constraints of the retroperitoneum limit the ability to achieve wide resection margins; therefore, these tumors have a high rate of recurrence, and require long-term follow-up. The radiologist has an important role in the diagnosis of RPS, the definition of their extent, and their follow-up. Specific knowledge of the main imaging findings is required to reach an early diagnosis, and, ultimately, to guarantee the best patient management. This article provides an overview of the current knowledge regarding cross-sectional imaging features of patients with retroperitoneal sarcomas, presenting tips and tricks to improve imaging diagnosis of RPS.
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Affiliation(s)
- Giorgia Porrello
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnosis (Bi.N.D), University of Palermo, 90127 Palermo, Italy
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127 Palermo, Italy
| | - Roberto Cannella
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnosis (Bi.N.D), University of Palermo, 90127 Palermo, Italy
| | - Angelo Randazzo
- Department of Radiology, Azienda Sanitaria Provinciale, 92100 Agrigento, Italy
| | - Giuseppe Badalamenti
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences (DICHIRONS), University of Palermo, 90127 Palermo, Italy
| | - Giuseppe Brancatelli
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnosis (Bi.N.D), University of Palermo, 90127 Palermo, Italy
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padova, 35128 Padova, Italy
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Ohtsu A, Arai S, Fujizuka Y, Fukuda R, Hori K, Morimura Y, Kawahara R, Shiraishi T, Ogawa H, Miyazawa Y, Nomura M, Sekine Y, Koike H, Matsui H, Suzuki K. Retroperitoneal urothelial carcinoma arising after bladder diverticulectomy: a case report. BMC Urol 2023; 23:88. [PMID: 37165362 PMCID: PMC10173469 DOI: 10.1186/s12894-023-01266-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/03/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Urothelial carcinoma arises from the inner urothelial membrane of the renal pelvis, ureter, and bladder and often causes macrohematuria. Here, we report a rare case in which the patient developed non-symptomatic urothelial carcinoma anatomically outside the bladder wall 17 years after bladder diverticulectomy. CASE PRESENTATION An 82-year-old male patient previously underwent gastrectomy for stomach cancer and partial hepatectomy for intrahepatic cholangiocarcinoma. Follow-up computed tomography revealed a tumor in the retroperitoneal space, where a bladder diverticulum was removed 17 years earlier. Multiparametric magnetic resonance imaging suggested that the tumor was malignant with rectal invasion. Subsequent computed tomography-guided percutaneous biopsy revealed that the tumor was urothelial carcinoma. The patient underwent two courses of neoadjuvant chemotherapy followed by pelvic exenteration with pelvic lymph node dissection. He is currently receiving adjuvant therapy with an immune checkpoint inhibitor and has had no recurrence for 3 months. CONCLUSIONS Multiparametric magnetic resonance imaging is a helpful tool for predicting both tumor malignancy and invasion before a pathologically confirmed diagnosis. Although this case is rare, urologists should be aware of the occurrence of urothelial carcinoma after bladder diverticulectomy in cases of incomplete resection of the diverticulum.
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Affiliation(s)
- Akira Ohtsu
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Seiji Arai
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan.
| | - Yuji Fujizuka
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Reon Fukuda
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Keisuke Hori
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Yuki Morimura
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Rintaro Kawahara
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Takuya Shiraishi
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Hiroomi Ogawa
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Yoshiyuki Miyazawa
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Masashi Nomura
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Yoshitaka Sekine
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Hidekazu Koike
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Hiroshi Matsui
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
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28
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El Charif MH, Tarhini H, Dushfunian D, Al Harake H, Khasawneh H, Abi Saad G, Khalife M, Sbaity E. Retroperitoneal desmoid-type fibromatosis: a case report. Ann Med Surg (Lond) 2023; 85:1258-1261. [PMID: 37113969 PMCID: PMC10129236 DOI: 10.1097/ms9.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/18/2023] [Indexed: 04/29/2023] Open
Abstract
Desmoid-type fibromatosis (DF) is a rare subtype of soft tissue sarcomas that most commonly occurs in the anterior abdominal wall. When occurring in the retroperitoneum, DF is usually part of familial syndromes while only rarely sporadic. This makes it imperative to report any instance of experience with DF and the oncological outcomes of the different approaches to management. We report two cases of sporadic and severe DF occurring in the retroperitoneum at our institution. Case presentation The first case is a male that presented with urinary obstruction symptoms and underwent surgical resection of the tumor that extended into the left kidney. The second case is a female with a history of recurrent desmoid tumors of the thigh and was incidentally diagnosed with retroperitoneal DF on imaging. She underwent tumor resection and radiotherapy; however, the tumor recurred with urinary obstruction symptoms that required another surgical resection. Histopathological characteristics and radiological imaging of both cases are described below. Clinical discussion Desmoid tumors often recur, thus significantly influencing the quality of life which is reflected in one of our cases. Surgery remains a mainstay treatment, and both cases presented in this report required surgical resection of the tumors as symptomatic and curative measures. Conclusion Retroperitoneal DF is a rare entity, and our cases add to the scarce literature available on the topic, which may well contribute to the formulation of practice-changing recommendations and guidelines focused on this rare variant of DF.
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Affiliation(s)
| | | | | | | | - Hala Khasawneh
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Eman Sbaity
- Department of Surgery
- Corresponding author. Address: Riad El Solh, Beirut 1107 2020, Lebanon. Tel.: +961 377 1917. E-mail address: (E. Sbaity)
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29
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Pitot MA, Gu CN, Adamo DA, Kurup AN, Schmitz JJ, Packard AT. Safety and accuracy of aortic and periaortic CT-guided percutaneous core needle biopsy. Abdom Radiol (NY) 2023; 48:2148-2156. [PMID: 36939909 DOI: 10.1007/s00261-023-03867-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE The purpose of this study was to determine the safety and accuracy of aortic and periaortic computed tomography (CT)-guided percutaneous core needle biopsy performed at a single center over 12 years. MATERIALS AND METHODS A retrospective review was conducted of cases performed between February 2010 and August 2022 in which the biopsied region was in direct contact with the aorta or great vessels including the pericardium and common iliac arteries. Clinical notes were reviewed for any early or delayed complications following the procedure, which if present were graded using the National Institute of Health's Common Terminology Criteria for Adverse Events, version 5.0. Pathology results were compared to subsequent outside biopsy results or follow-up surgical pathology, if available, as well as subsequent clinical decision making and/or clinical course, to determine concordance. Sensitivity, specificity, predictive value, and accuracy (indicative of diagnostic yield) were calculated. RESULTS 32 core needle biopsies were reviewed from 30 patients (average lesion longest diameter 3.1 cm, range 0.5-10.9 cm; average needle proximity to the vessel endothelium or deep side of the pericardium 1.0 cm, range 0.3-1.8 cm). Complications occurred in 46.9% of cases (15/32), 93.3% (14/15) of which were minor and included small amounts of bleeding or pain. One patient developed a small nonemergent pneumothorax. Of biopsies obtained, 96.9% provided adequate tissue for diagnosis (31/32). When evaluating concordance between pathological and final diagnosis, sensitivity was 94.7% and specificity was 83.3%; positive and negative predictive value were 90.0% and 90.9%, respectively. Accuracy (diagnostic yield) of biopsy was 90.3%. CONCLUSION CT-guided percutaneous aortic and periaortic core needle biopsies are safe and efficacious procedures with high diagnostic yield.
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Affiliation(s)
- Marika A Pitot
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
| | - Chris N Gu
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Anil Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Annie T Packard
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
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30
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Review of diagnosis, differential diagnosis, and management of retroperitoneal lymphangioma. Jpn J Radiol 2023; 41:283-301. [PMID: 36327088 DOI: 10.1007/s11604-022-01356-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
Lymphatic malformation (LM) is the currently preferred term for what was previously known as lymphangioma. Retroperitoneal LMs are extremely rare, benign, cystic masses that arise from lymphatic vessels. They can be challenging to diagnose because they resemble other retroperitoneal cystic tumors. The development of treatment strategies for rare diseases, including retroperitoneal LM, requires the acquisition of new knowledge to enhance our understanding of the disease progression. Therefore, we present an update regarding fundamental and advanced issues associated with retroperitoneal LM. This review describes the epidemiology, histopathology, biomedicine, clinical manifestations, radiological features, differential diagnosis, and management of this lesion.
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31
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Extramedullary Hematopoiesis: A Forgotten Diagnosis and a Great Mimicker of Malignancy. J Comput Assist Tomogr 2023; 47:445-452. [PMID: 36728149 DOI: 10.1097/rct.0000000000001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Radiology errors have been reported in up to 30% of cases when patients have abnormal imaging findings. Although more than half of errors are failures to detect critical findings, over 40% of errors are when findings are recognized but the correct diagnosis or interpretation is not made. One common source of error is when imaging findings from one process simulate imaging findings from another process but the correct diagnosis is not made. This can result in additional imaging studies, unnecessary biopsies, or surgery. Extramedullary hematopoiesis is one of those uncommon disease processes that can produce many imaging findings that may lead to misdiagnosis. The objective of this article is to review the common and uncommon imaging features of extramedullary hematopoiesis while presenting a series of interesting relevant illustrative cases with emphasis on CT.
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32
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Yoshitake R, Baba M, Kubota S, Kageyama S, Kawauchi A. [A CASE OF PERIVESICAL ABSCESS CAUSED BY MIGRATION OF A FOREIGN BODY FROM THE INTESTINAL TRACT]. Nihon Hinyokika Gakkai Zasshi 2023; 114:70-74. [PMID: 38644190 DOI: 10.5980/jpnjurol.114.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
A 76-year-old woman was referred to our department because of high fever and bladder irritative symptoms. Computed tomography revealed the presence of a heterogeneous mass with indistinct borders on the left anterior wall of the bladder. The lesion contained a linear hyperdense shadow. We initially suspected malignancy, such as urachal carcinoma or soft-tissue sarcoma. However, upon review of previous computed tomography scans, it was confirmed that the linear hyperdense shadow had migrated from the intestinal tract to the bladder. Considering the possibility of abscess formation caused by a foreign body, we decided to perform a transurethral biopsy. The results of the pathological analysis showed abscess formation. The patient was diagnosed with perivesical abscess caused by accidental ingestion of a fish bone. Following the administration of antibiotics, the lesion markedly shrank. Although it is difficult to distinguish perivesical abscess from malignant disease, invasive treatment can be avoided by appropriate diagnosis based on imaging studies.
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Affiliation(s)
- Rintaro Yoshitake
- The Department of Urology Shiga University of Medical Science Hospital
| | - Masato Baba
- The Department of Urology Shiga University of Medical Science Hospital
| | - Shigetoshi Kubota
- The Department of Urology Shiga University of Medical Science Hospital
| | - Susumu Kageyama
- The Department of Urology Shiga University of Medical Science Hospital
| | - Akihiro Kawauchi
- The Department of Urology Shiga University of Medical Science Hospital
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33
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Mehri A, Esparham A, Rezaei R. Primary retroperitoneal hydatid cyst, a rare novel differential diagnosis of retroperitoneal masses: A case report. Clin Case Rep 2022; 10:e6615. [PMID: 36419575 PMCID: PMC9676128 DOI: 10.1002/ccr3.6615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/18/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022] Open
Abstract
The presence of primary retroperitoneal hydatid cysts is rare, even in endemic areas. The authors report a young man with a retroperitoneal hydatid cyst who underwent total cystectomy. The surgeons should suspect hydatid cysts in case of any abdominal cysts, especially in endemic areas, and avoid any spillage and puncture.
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Affiliation(s)
- Ali Mehri
- Endoscopic and Minimally Invasive Surgery Research CenterMashhad University of Medical SciencesMashhadIran
| | - Ali Esparham
- Student Research Committee, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Reza Rezaei
- Department of Thoracic Surgery, Endoscopic and Minimally Invasive Surgery Research CenterMashhad University of Medical SciencesMashhadIran
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34
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Agirlar Trabzonlu T, Modak M, Horowitz JM. MR Imaging of Mimics of Adnexal Pathology. Magn Reson Imaging Clin N Am 2022; 31:137-148. [DOI: 10.1016/j.mric.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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35
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Sarcoma de Ewing retroperitoneal: un reto diagnóstico. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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36
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Sreedher G, Tadros SS, Janitz E. Pediatric mediastinal masses. Pediatr Radiol 2022; 52:1935-1947. [PMID: 35674800 DOI: 10.1007/s00247-022-05409-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/21/2022] [Accepted: 05/14/2022] [Indexed: 12/01/2022]
Abstract
Mediastinal masses are categorized based on the International Thymic Malignancy Interest Group (ITMIG) classification into prevascular, visceral and paravertebral compartments. The schema is based on cross-sectional imaging, mainly CT, and helps with generating a differential diagnosis based on location of the mass. Up to half of all pediatric mediastinal tumors are malignant. In this review we describe mediastinal masses that are relevant to the pediatric population, as well as the role of MR imaging of mediastinal masses and its advantages.
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Affiliation(s)
- Gayathri Sreedher
- Department of Radiology, Akron Children's Hospital, One Perkins Square, Akron, OH, 44308, USA. .,Department of Pediatric Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Sameh S Tadros
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Emily Janitz
- Department of Radiology, Akron Children's Hospital, One Perkins Square, Akron, OH, 44308, USA
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37
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Pierre T, Selhane F, Zareski E, Garcia C, Fizazi K, Loriot Y, Patrikidou A, Naoun N, Bernard-Tessier A, Baumert H, Lebacle C, Blanchard P, Rocher L, Balleyguier C. The Role of CT in the Staging and Follow-Up of Testicular Tumors: Baseline, Recurrence and Pitfalls. Cancers (Basel) 2022; 14:3965. [PMID: 36010958 PMCID: PMC9406011 DOI: 10.3390/cancers14163965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/30/2022] Open
Abstract
Ultrasound imaging of the testis represents the standard-of-care initial imaging for the diagnosis of TGCT, whereas computed tomography (CT) plays an integral role in the initial accurate disease staging (organ-confined, regional lymph nodes, or sites of distant metastases), in monitoring the response to therapy in patients who initially present with non-confined disease, in planning surgical approaches for residual masses, in conducting follow-up surveillance and in determining the extent of recurrence in patients who relapse after treatment completion. CT imaging has also an important place in diagnosing complications of treatments. The aims of this article are to review these different roles of CT in primary TGCT and focus on different pitfalls that radiologists need to be aware of.
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Affiliation(s)
- Thibaut Pierre
- Department of Radiology, Gustave Roussy, 114 Rue Edouard-Vaillant, 94800 Villejuif, France
| | - Fatine Selhane
- Department of Radiology, Gustave Roussy, 114 Rue Edouard-Vaillant, 94800 Villejuif, France
- School of Medicine, University of Paris-Saclay, Cancer Campus, 94800 Villejuif, France
| | - Elise Zareski
- Department of Radiology, Gustave Roussy, 114 Rue Edouard-Vaillant, 94800 Villejuif, France
| | - Camilo Garcia
- Department of Nuclear Medicine, Gustave Roussy, 114 Rue Edouard-Vaillant, 94800 Villejuif, France
| | - Karim Fizazi
- School of Medicine, University of Paris-Saclay, Cancer Campus, 94800 Villejuif, France
- Department of Oncology, Gustave Roussy, 114 Rue Edouard-Vaillant, 94800 Villejuif, France
| | - Yohann Loriot
- Department of Oncology, Gustave Roussy, 114 Rue Edouard-Vaillant, 94800 Villejuif, France
| | - Anna Patrikidou
- Department of Oncology, Gustave Roussy, 114 Rue Edouard-Vaillant, 94800 Villejuif, France
| | - Natacha Naoun
- Department of Oncology, Gustave Roussy, 114 Rue Edouard-Vaillant, 94800 Villejuif, France
| | - Alice Bernard-Tessier
- School of Medicine, University of Paris-Saclay, Cancer Campus, 94800 Villejuif, France
- Department of Oncology, Gustave Roussy, 114 Rue Edouard-Vaillant, 94800 Villejuif, France
| | - Hervé Baumert
- Department of Urology, Gustave Roussy, 114 Rue Edouard-Vaillant, 94800 Villejuif, France
| | - Cédric Lebacle
- Department of Urology, Kremlin Bicêtre Hospital, APHP, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Pierre Blanchard
- School of Medicine, University of Paris-Saclay, Cancer Campus, 94800 Villejuif, France
- Department of Radiation Oncology, Gustave Roussy, 114 Rue Edouard-Vaillant, 94800 Villejuif, France
| | - Laurence Rocher
- School of Medicine, University of Paris-Saclay, Cancer Campus, 94800 Villejuif, France
- Department of Radiology, Antoine-Béclère Hospital, APHP, 157 Rue de la Porte de Trivaux, 92140 Clamart, France
| | - Corinne Balleyguier
- Department of Radiology, Gustave Roussy, 114 Rue Edouard-Vaillant, 94800 Villejuif, France
- School of Medicine, University of Paris-Saclay, Cancer Campus, 94800 Villejuif, France
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Sang NV, Ninh TP, Thanh DT, Thinh NC. A case report of mesenteric involvement in neurofibromatosis type 1. J Clin Imaging Sci 2022; 12:43. [PMID: 36128353 PMCID: PMC9479501 DOI: 10.25259/jcis_49_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/11/2022] [Indexed: 11/05/2022] Open
Abstract
Mutations in the Neurofibromatosis Type 1 (NF-1) gene, which is located on chromosome 17q11.2, are the cause of NF-1, an autosomal dominant hereditary condition in which tumors of the nerve system develop. Neurological, skeletal, and cutaneous abnormalities are symptoms of the condition. Of all gastrointestinal tract lesions, mesentery lesions are the least common. There are many gastrointestinal problems that can accompany mesenteric neurofibromas, or they may not. We describe a case of a 5-year-old kid with mesenteric neurofibromatosis, which results in bowel obstruction and abdominal discomfort. On a CT scan, the mesenteric vasculature was completely encircled by homogenous soft tissue lesions without any vessel wall invasion. Diffuse mesentery lesions were discovered during surgery, although they could not be fully removed.
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Affiliation(s)
- Nguyen Van Sang
- Department of Radiology, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Tran Phan Ninh
- Department of Radiology, Vietnam National Children’s Hospital, Ha Noi, Vietnam
| | | | - Nguyen Cuong Thinh
- Department of Gastroenterology, 108 Military Central Hospital, Ha Noi, Vietnam
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Gulati V, Swarup MS, Kumar J. Solid Primary Retroperitoneal Masses in Adults: An Imaging Approach. Indian J Radiol Imaging 2022; 32:235-252. [PMID: 35924125 PMCID: PMC9340194 DOI: 10.1055/s-0042-1744142] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mass lesions in the retroperitoneal space may be primary or secondary. Primary retroperitoneal mass lesions are relatively uncommon as compared to pathology that arises secondarily from retroperitoneal organs. These may be solid or cystic lesions. The overlapping imaging features of various solid primary retroperitoneal tumors make the diagnosis difficult, and hence, histopathology remains the mainstay of diagnosis. This paper provides a brief review of the anatomy of the retroperitoneal space and provides an algorithmic approach based on cross-sectional imaging techniques to narrow down the differential diagnosis of solid primary retroperitoneal masses encountered in the adult population.
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Affiliation(s)
- Vaibhav Gulati
- Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - M. Sarthak Swarup
- Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Jyoti Kumar
- Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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40
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Bello HR, Sekhar A, Filice RW, Radmard AR, Davarpanah AH. Pancreaticoduodenal Groove: Spectrum of Disease and Imaging Features. Radiographics 2022; 42:1062-1080. [PMID: 35594198 DOI: 10.1148/rg.210168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The pancreaticoduodenal groove (PDG) is a small space between the pancreatic head and duodenum where vital interactions between multiple organs and physiologic processes take place. Muscles, nerves, and hormones perform a coordinated dance, allowing bile and pancreatic enzymes to aid in digestion and absorption of critical nutrition. Given the multitude of organs and cells working together, a variety of benign and malignant entities can arise in or adjacent to this space. Management of lesions in this region is also complex and can involve observation, endoscopic resection, or challenging surgeries such as the Whipple procedure. The radiologist plays an important role in evaluation of abnormalities involving the PDG. While CT is usually the first-line examination for evaluation of this complex region, MRI offers complementary information. Although features of abnormalities involving the PDG can often overlap, understanding the characteristic imaging and pathologic features generally allows categorization of disease entities based on the suspected organ of origin and the presence of ancillary features. The goal of the authors is to provide radiologists with a conceptual approach to entities implicating the PDG to increase the accuracy of diagnosis and assist in appropriate management or presurgical planning. They briefly discuss the anatomy of the PDG, followed by a more in-depth presentation of the features of disease categories. A table summarizing the entities that occur in this region by underlying cause and anatomic location is provided. ©RSNA, 2022.
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Affiliation(s)
- Hernan R Bello
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, 1365-A Clifton Rd NE, Suite AT-627, Atlanta, GA 30322 (H.R.B., A.S., A.H.D.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.W.F.); and Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (A.R.R.)
| | - Aarti Sekhar
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, 1365-A Clifton Rd NE, Suite AT-627, Atlanta, GA 30322 (H.R.B., A.S., A.H.D.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.W.F.); and Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (A.R.R.)
| | - Ross W Filice
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, 1365-A Clifton Rd NE, Suite AT-627, Atlanta, GA 30322 (H.R.B., A.S., A.H.D.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.W.F.); and Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (A.R.R.)
| | - Amir Reza Radmard
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, 1365-A Clifton Rd NE, Suite AT-627, Atlanta, GA 30322 (H.R.B., A.S., A.H.D.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.W.F.); and Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (A.R.R.)
| | - Amir H Davarpanah
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, 1365-A Clifton Rd NE, Suite AT-627, Atlanta, GA 30322 (H.R.B., A.S., A.H.D.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.W.F.); and Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (A.R.R.)
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A desmoid-type fibromatosis in the retroperitoneum of the gastro-pancreatic region that was resected with a distal pancreatomy: a case report. Radiol Case Rep 2022; 17:2573-2578. [PMID: 35634017 PMCID: PMC9130081 DOI: 10.1016/j.radcr.2022.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/20/2022] [Indexed: 11/24/2022] Open
Abstract
An 80-year-old man was referred to our hospital because of epigastric pain. Abdominal computed tomography revealed a well-defined circular intra-abdominal mass in the gastro-pancreatic region measuring 15 mm in diameter. After 6 months, the mass lesion was growing with mild enhancement, and weaker enhancement was found in the lower half of the mass on contrast-enhanced computed tomography. The mass lesion touched the stomach, whereas adipose tissue appeared to intervene between the mass and pancreas. On magnetic resonance imaging, the well-defined mass lesion had isointensity to muscle on T1-weighted imaging, slight hyperintensity to muscle on T2-weighted imaging, which indicated a rich fibrous tumor. Under general anesthesia, the patient underwent open surgery. Intraoperatively, the tumor was separated from the stomach and firmly attached to the pancreas. Therefore, we performed a distal pancreatomy with splenic resection. Pathological diagnosis was desmoid-type fibromatosis in the retroperitoneum, and the tumor margin was attached to the pancreas, splenic artery, and splenic vein. Since there are few reports of desmoid-type fibromatosis occurring in the retroperitoneum of the gastropancreatic region, it is difficult to distinguish from other soft tissue tumors and to identify the tumor origin. Close observation by radiological re-valuation was a useful option. Magnetic resonance imaging signals and an enhanced pattern may help distinguish a desmoid-type fibromatosis from other soft tissue tumors. A desmoid-type fibromatosis that is well-defined in radiological findings may infiltrate the surrounding organs with gross or pathological analyses.
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Neuroendocrine Neoplasms of the Female Genitourinary Tract: A Comprehensive Overview. Cancers (Basel) 2022; 14:cancers14133218. [PMID: 35804996 PMCID: PMC9264819 DOI: 10.3390/cancers14133218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Primary neuroendocrine neoplasms (NENs) are a rare, heterogeneous group of tumors that include well-differentiated neuroendocrine tumors, poorly differentiated neuroendocrine carcinoma, and paraganglioma. NENs in the urinary tract are observed in <0.05% of individuals, in whom the bladder is the most common site. In this review, we described the epidemiology, pathogenesis, imaging, staging, and management of the genitourinary NENs. Abstract Primary neuroendocrine neoplasms are a rare heterogeneous group of tumors that include well-differentiated neuroendocrine tumors, poorly differentiated neuroendocrine carcinoma, and paraganglioma. An extensive literature search was used to compile the data regarding epidemiology, pathogenesis, imaging features, and management of the urinary system NENs. We also included the updated staging of the NENs at various locations of the urinary system.
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Macchini D, Perano V, Celoria V, Bombardieri E, Goletti O. Robotic-assisted resection of pelvic mesorectum lipoma during the COVID-19 pandemic: a case report. J Surg Case Rep 2022; 2022:rjac113. [PMID: 35712609 PMCID: PMC9197174 DOI: 10.1093/jscr/rjac113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/07/2022] [Indexed: 11/20/2022] Open
Abstract
Mesorectal lipoma is a rare, usually asymptomatic tumor. The best treatment is R0 resection but the previous literature reports different approaches. Robotic surgery allows for an accurate intervention, with a faster postoperative course, less risk of infection and need for transfusions, a faster return to normal daily activities and the best esthetic result. We describe a case of a 43-year-old female with a large lipoma with dislocation of the vagina, rectum and distal sigmoid colon, potentially malignant, successfully treated by robotic excision, which was safe, effective and well tolerated by the patient.
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Affiliation(s)
- Daniele Macchini
- Department of General Surgery , Humanitas Gavazzeni, Bergamo, Italy
- School of General Surgery , Humanitas University, Rozzano, Italy
| | - Vittoria Perano
- School of General Surgery , Humanitas University, Rozzano, Italy
| | | | | | - Orlando Goletti
- Department of General Surgery , Humanitas Gavazzeni, Bergamo, Italy
- School of General Surgery , Humanitas University, Rozzano, Italy
- Translational Research Department , University of Pisa, Pisa, Italy
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Costa P, Costa C. Retroperitoneal Ewing Sarcoma: a challenging diagnosis. RADIOLOGIA 2022; 64:490-493. [DOI: 10.1016/j.rxeng.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/27/2021] [Indexed: 11/26/2022]
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Schwannoma in and around the porta hepatis: radiological features in eight cases and literature review. Abdom Radiol (NY) 2022; 47:1917-1928. [PMID: 35488897 DOI: 10.1007/s00261-022-03524-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE Schwannomas in and around the porta hepatis (porta hepatic schwannomas) are rare benign tumors easily misdiagnosed as other pathologies, including malignancies. We aimed to evaluate their imaging features on ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT). METHODS We performed a multi-institutional retrospective study by reviewing the clinical and imaging findings of pathologically proven eight porta hepatic schwannomas (mean age, 55 years; range, 38-80 years; one male and seven females). Preoperative imaging included three ultrasonography, eight CT, eight MRI, and two FDG-PET/CT. RESULTS All patients were asymptomatic. The mean tumor size was 61.9 mm (range, 30-180 mm), and all tumors demonstrated well-defined lesions on ultrasonography and their solid components showed soft tissue attenuation on non-contrast CT. MRI showed two distinct components in all cases: the component with T1-weighted hypointensities and T2-weighted hyperintensities with poor enhancement (suggestive of Antoni B histology); the component with T2-weighted hypointensities with gradually increasing enhancement (suggestive of Antoni A histology), resulting in a heterogeneous pattern on post-contrast CT or MRI (8/8, 100%). The separated deviation of surrounding bile ducts and vessels without obstruction allowed the recognition of extrahepatic localization and their benign nature. A ginger root-like morphology (2/8, 25%) seemed to be suggestive of extension along the Glisson's sheath, although this finding was not seen frequently. CONCLUSION Recognizing imaging features such as extrahepatic location, benign nature with internal structures suggestive of Antoni A/B histology, and characteristic tumor extension may provide key diagnostic clues for porta hepatic schwannomas.
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Guo X, Wei Z, Wang M, Zhang Y. Treatment of a Double Cancer Patient With Primary Inferior Vena Cava Sarcoma and Lung Adenocarcinoma: A Case Report and Literature Review. Front Surg 2022; 9:852757. [PMID: 35465439 PMCID: PMC9019075 DOI: 10.3389/fsurg.2022.852757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignancy. Here, we present the case of a 38-year-old woman with a primary IVC leiomyosarcoma and lung adenocarcinoma. Case Report The patient, a 38-year-old Chinese female, presented to the general surgical outpatients clinic with a 18-month history of intermittent right upper abdominal pain. Contrast-enhanced computed tomography (CT) showed a tumor of IVC (3.4*2.7 cm) extending to the renal veins. In addition, chest CT revealed a mass lesion in the upper left lung lobe. Then, the patient underwent resection of the IVC tumor and wedge resection of the upper lobe of the left lung. The patient then received gefitinib (250 mg/day) as a maintenance therapy until the tumor recurrence or metastasis in the follow-up period. Pulmonary metastasis of the sarcoma were first diagnosed 20 month after the resection of the IVC leiomyosarcoma. So the patient again received thoracoscopic wedge pneumonectomy, and it was confirmed to be metastasis of IVC leiomyosarcoma. The patient received oral anlotinib treatment (12 mg once daily) after the last operation. During on-going regular follow-up visits no evidence of recurrence or metastasis was observed from December 2020 to October 2021. Conclusions The patient with a primary IVC leiomyosarcoma and lung adenocarcinoma is extremely rare. Surgery is still an effective treatment for patients with a primary IVC leiomyosarcoma and lung adenocarcinoma at present.
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47
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Arslan S, Sarıkaya Y, Akata D, Özmen MN, Karçaaltıncaba M, Karaosmanoğlu AD. Imaging findings of spontaneous intraabdominal hemorrhage: neoplastic and non-neoplastic causes. Abdom Radiol (NY) 2022; 47:1473-1502. [PMID: 35230499 DOI: 10.1007/s00261-022-03462-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 02/07/2023]
Abstract
Contrary to traumatic and iatrogenic intraabdominal hemorrhages, spontaneous intraabdominal hemorrhage is a challenging clinical situation. A variety of neoplastic and non-neoplastic conditions may cause spontaneous intraabdominal bleeding. Imaging findings vary depending on the source of bleeding and the underlying cause. In this article, we aim to increase the awareness of imagers to the most common causes of spontaneous intraabdominal hemorrhage by using representative cases.
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Affiliation(s)
- Sevtap Arslan
- Department of Radiology, Suhut State Hospital, 03800, Afyon, Turkey
| | - Yasin Sarıkaya
- Department of Radiology, Afyonkarahisar Health Sciences University, 03217, Afyon, Turkey
| | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06230, Ankara, Turkey
| | - Mustafa Nasuh Özmen
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06230, Ankara, Turkey
| | - Muşturay Karçaaltıncaba
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06230, Ankara, Turkey
| | - Ali Devrim Karaosmanoğlu
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06230, Ankara, Turkey.
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Serizawa I, Kusano Y, Kano K, Shima S, Tsuchida K, Takakusagi Y, Mizoguchi N, Kamada T, Yoshida D, Katoh H. Three cases of retroperitoneal sarcoma in which bioabsorbable spacers (bioabsorbable polyglycolic acid spacers) were inserted prior to carbon ion radiotherapy. JOURNAL OF RADIATION RESEARCH 2022; 63:296-302. [PMID: 35152291 PMCID: PMC8944322 DOI: 10.1093/jrr/rrac002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/17/2021] [Indexed: 06/14/2023]
Abstract
From August 2019 to August 2020, we inserted polyglycolic acid (PGA) spacers and administered carbon ion radiotherapy (CIRT) to three cases of retroperitoneal sarcoma at our hospital. We aimed to investigate its utility and safety for retroperitoneal sarcoma. We analyzed changes in PGA spacer volume and corresponding computed tomography (CT) values in addition to the dose distribution using in-room CT images that were obtained during treatment. We assessed adverse events and investigated the suitability, safety and effectivity of PGA spacer insertion. During treatment, changes in PGA spacer volumes and CT values were confirmed. Volumes increased in patients with a folded PGA spacer, and it increased 1.6-fold by the end of irradiation compared with planning CT. The CT values decreased by 20-50 Hounsfield units at the end of irradiation compared to the planning CT. Dose distribution evaluation showed that the dose to the gastrointestinal tract adjacent to the tumor was maintained below the tolerable dose, and a sufficient dose was delivered to the target by PGA spacer insertion. One case of subileus caused during abdominal surgery for PGA spacer insertion occurred. No other adverse events, such as digestive disorders, were observed. CIRT with PGA spacer insertion for retroperitoneal sarcomas is safe and effective. For cases in which there is no option but to perform irradiation using a PGA spacer, precautionary measures such as verification of dose distributions using CT images are necessary.
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Affiliation(s)
- Itsuko Serizawa
- Corresponding author. Itsuko Serizawa, MD, PhD, Department of Radiation Oncology, Kanagawa Cancer Center, 241-8515, Asahi-ku, Yokohama, Kanagawa, Japan. Tel: +81 455202222; Fax: +81 455202202; E-mail:
| | - Yohsuke Kusano
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Yokohama 241-8515, Japan
| | - Kio Kano
- Department of Radiation Oncology, Kanagawa Cancer Center, Kanagawa 241-8515, Japan
| | - Satoshi Shima
- Department of Radiation Oncology, Kanagawa Cancer Center, Kanagawa 241-8515, Japan
| | - Keisuke Tsuchida
- Department of Radiation Oncology, Kanagawa Cancer Center, Kanagawa 241-8515, Japan
| | - Yosuke Takakusagi
- Department of Radiation Oncology, Kanagawa Cancer Center, Kanagawa 241-8515, Japan
| | - Nobutaka Mizoguchi
- Department of Radiation Oncology, Kanagawa Cancer Center, Kanagawa 241-8515, Japan
| | - Tadashi Kamada
- Department of Radiation Oncology, Kanagawa Cancer Center, Kanagawa 241-8515, Japan
| | - Daisaku Yoshida
- Department of Radiation Oncology, Kanagawa Cancer Center, Kanagawa 241-8515, Japan
| | - Hiroyuki Katoh
- Department of Radiation Oncology, Kanagawa Cancer Center, Kanagawa 241-8515, Japan
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Elsherif SB, Agely A, Gopireddy DR, Ganeshan D, Hew KE, Sharma S, Lall C. Mimics and Pitfalls of Primary Ovarian Malignancy Imaging. Tomography 2022; 8:100-119. [PMID: 35076619 PMCID: PMC8788482 DOI: 10.3390/tomography8010009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
The complex anatomy and similarity of imaging features of various pathologies in the pelvis can make accurate radiology interpretation difficult. While prompt recognition of ovarian cancer remains essential, awareness of processes that mimic ovarian tumors can avoid potential misdiagnosis and unnecessary surgery. This article details the female pelvic anatomy and highlights relevant imaging features that mimic extra-ovarian tumors, to help the radiologists accurately build a differential diagnosis of a lesion occupying the adnexa.
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Affiliation(s)
- Sherif B. Elsherif
- Department of Radiology, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, USA; (D.R.G.); (S.S.); (C.L.)
| | - Ali Agely
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL 32224, USA;
| | - Dheeraj R. Gopireddy
- Department of Radiology, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, USA; (D.R.G.); (S.S.); (C.L.)
| | | | - Karina E. Hew
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, USA;
| | - Smita Sharma
- Department of Radiology, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, USA; (D.R.G.); (S.S.); (C.L.)
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, USA; (D.R.G.); (S.S.); (C.L.)
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Traub B, Haggenmüller B, Baumann L, Lemke J, Henne-Bruns D, Wittau M. Unclear retroperitoneal tumors, an interdisciplinary challenge - A case report and review of the literature. Int J Surg Case Rep 2021; 89:106634. [PMID: 34864261 PMCID: PMC8645916 DOI: 10.1016/j.ijscr.2021.106634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/21/2021] [Accepted: 11/21/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Unclear retroperitoneal tumors impose major challenges for clinicians. Tumors can originate primarily from retroperitoneal tissue or secondarily invade into the retroperitoneum. While benign lesions also occur, malignant tumors are far more common. Clinical presentation depends on replacement or invasion of other organs and is therefore highly variable. The heterogeneous tumor composition makes a definitive preoperative diagnosis difficult. Surgical resection is the gold standard for treatment but often proves challenging due to frequent involvement of large retroperitoneal vessels. CASE PRESENTATION We present the case of a 70-year old woman diagnosed with a large, unclear retroperitoneal tumor. Initial clinical symptoms were increasing dyspnea and dysphagia in our clinic. Gastroenterologic and cardiologic workup was unremarkable. Computed Tomography (CT) revealed a large retroperitoneal mass in the right upper abdomen with severe displacement of the inferior vena cava and renal veins. The patient was scheduled for primary tumor resection. The procedure was challenging due to the vessel involvement and large blood pressure alterations during tumor mobilization. The post-op pathologic workup then revealed the rare finding of a completely resected paraganglioma. The post-surgical course was uneventful. One year after diagnosis, the patient is relapse-free. CLINICAL DISCUSSION Among retroperitoneal tumors, paragangliomas and pheochromocytomas are rare tumor entities. Asymptomatic, sporadic disease is hard to identify preoperatively and can cause unexpected complications in the OR. An experienced team is crucial in achieving best short- and long-term outcomes. CONCLUSION This case impressively shows the challenges of retroperitoneal tumors and the importance of interdisciplinary work in these cases.
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Affiliation(s)
- Benno Traub
- Department of General and visceral surgery, University Hospital of Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany.
| | - Benedikt Haggenmüller
- Department of Radiology, University Hospital of Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Lisa Baumann
- Department of Pathology, University Hospital of Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Johannes Lemke
- Department of General and visceral surgery, University Hospital of Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Doris Henne-Bruns
- Department of General and visceral surgery, University Hospital of Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Mathias Wittau
- Department of General and visceral surgery, University Hospital of Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
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